The Best Way to Rehab an ACL Tear After Surgery

If you’ve had ACL surgery, you already know how tough the road back can feel. The swelling, stiffness, and loss of strength can make it seem like you’re starting from scratch. But with the right plan, you can rebuild faster and stronger than before.

At Bax Performance and Rehab, we don’t do cookie-cutter protocols. We use a performance-based progression that starts with retraining your brain-to-muscle connection and ends with high-level movement, strength, and confidence. Let’s walk through how that process actually works.

Phase 1: Reconnecting the Brain and the Muscle

After ACL reconstruction, your quadriceps “shut down.” It’s not that you suddenly became weak, rather, it’s that your brain temporarily stops sending strong signals to that muscle. This neural inhibition is one of the biggest early hurdles in ACL recovery.

Why It Happens

Post-surgery swelling and joint trauma cause your nervous system to protect the knee by turning down the signal to the quad. Even if you try to contract it, the muscle doesn’t fire efficiently. That’s why early rehab can feel so frustrating — your leg just won’t cooperate.

How We Fix It

This is where neuromuscular electrical stimulation (NMES) comes in. By sending a controlled electrical signal directly to your quad, we “wake up” the muscle and rebuild that brain-to-muscle connection.

At BPR, we don’t just strap on a stim unit and let the machine do all the work. We pair NMES with active movement, so the signal your brain sends lines up with the external stimulation.

One of our go-to drills? Backward walking with NMES.

• Each time you take a step back, the stim fires the quad.

• This teaches your brain to contract at the right time, building quality movement patterns.

• It also promotes full knee extension and reduces early atrophy.

If you’re one week post-op and not doing NMES-assisted activation, you’re leaving progress on the table.

Phase 2: Regaining Strength and Mobility

Once the quad starts firing again, the next step is restoring range of motion and load tolerance.
We begin introducing controlled movements like heel slides, mini-squats, and step-ups while carefully managing swelling.

Key goals in this phase:

• Regain full knee extension early (critical for walking and proper mechanics).

• Gradually increase flexion tolerance.

• Begin low-load strengthening for the glutes, hamstrings, and calves.

We keep these sessions precise and intentional; no rushing into heavy lifting yet. The goal is control, not intensity.

Phase 3: Building Functional Strength

Once you can bear weight and control basic patterns, it’s time to move beyond the table.

In this phase, we introduce compound, athletic movements carefully designed to look and feel like what you’ll do back on the field, court, or gym floor.

What That Looks Like

• Split-stance Pallof presses – build rotational stability and teach your core to control torque through the trunk and hips.

• Hip thrusts and hinging drills – reinforce glute and hamstring strength while teaching proper hip drive.

• Banded step-outs and lateral walks – train hip control and spatial awareness, critical for knee stability.

Every exercise ties back to movement patterns you’ll use later: cutting, decelerating, or landing from a jump. By integrating strength, balance, and coordination, we rebuild your system from the ground up.

Phase 4: Dynamic Loading and Return to Sport

Once you’ve mastered strength and control, we start adding speed, impact, and unpredictability. This is where most traditional rehab stops, but performance-based rehab is just getting started.

Our ACL return-to-sport progression includes:

• Plyometrics and landing drills to retrain deceleration mechanics.

• Unilateral strength testing to ensure symmetry between legs.

• Agility, sprint, and change-of-direction work tailored to your sport.

• Psychological readiness — because confidence matters as much as strength.

By the time you’re cleared to compete, you’re not just “healed.” You’re ready to perform.

Why a Performance-Based Approach Works Better

Traditional ACL rehab often focuses on time-based protocols, hitting milestones at certain weeks post-op. But every athlete heals at a different rate, and your body doesn’t care about a calendar.

At BPR, we use a criteria-based system, meaning you progress when you’ve earned it, not just because another week passed.

That includes:

• Full, pain-free range of motion.

• Strength symmetry within 90% of the other leg.

• Excellent control in single-leg movements.

• Consistent landing and cutting mechanics.

This approach shortens downtime and drastically reduces the risk of re-injury.

Common Mistakes in ACL Rehab

1. Rushing the process. Jumping back into sport too early is the #1 cause of re-tears.

2. Avoiding quad activation. Without early NMES and backward walking, your strength gap can persist for months.

3. Neglecting the hips and core. Knee stability starts above and below the joint.

4. Skipping the mental side. Fear of re-injury can hold athletes back more than strength deficits.

The best rehab addresses all of these: physical, neurological, and psychological.

How Long Does It Take?

Recovery timelines vary, but here’s what most ACL patients experience at BPR:

By following these phases, athletes can return to full activity confidently, not cautiously.

🎥 Watch the Process in Action

See the techniques we use in the clinic to help athletes rebuild after ACL surgery:

These videos show real examples of how we combine technology, movement, and coaching to accelerate recovery.

The Takeaway

The best way to rehab an ACL tear after surgery isn’t about doing more, it’s about doing the right things at the right time.
From early quad activation with NMES to high-level stability and strength work, every phase matters.

When you rebuild properly, you don’t just get back to sport. You return stronger, more controlled, and more confident than ever.

Ready to Start Your ACL Recovery the Right Way?

Stop guessing and start progressing.
We’ll guide you through every phase — from post-op pain to performance.

📞 Call/Text: (925) 397-0399
📧 Email: Abigail@BaxPerformanceRehab.com

Sources

• American Physical Therapy Association – ACL Reconstruction Rehabilitation Guidelines

• Journal of Orthopaedic & Sports Physical Therapy – Criteria-Based Progression after ACL Recovery
   
  

• National Institutes of Health – Neuromuscular Electrical Stimulation and Early Quadriceps Activation